Healthcare Provider Details

I. General information

NPI: 1558359075
Provider Name (Legal Business Name): BARRY S BRICCA MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2295 S VINEYARD AVE
ONTARIO CA
91761
US

IV. Provider business mailing address

PO BOX 146
WRIGHTWOOD CA
92397-0146
US

V. Phone/Fax

Practice location:
  • Phone: 909-724-2286
  • Fax: 909-724-2291
Mailing address:
  • Phone: 760-249-5996
  • Fax: 909-724-2291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU713
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: